Background: This study investigated the efficacy and safety of immunotherapy plus chemotherapy in elderly patients with human epidermal growth factor receptor 2 (HER2)-negative advanced gastric cancer (AGC). Methods: This single-center retrospective study included patients with HER2-negative AGC who received nivolumab or pembrolizumab plus chemotherapy between November 2021 and October 2025. Patients were classified as non-elderly (<75 years) or elderly (>= 75 years). Endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and safety. Results: A total of 164 patients were selected (117 non-elderly, 47 elderly). The median PFS was 6.4 and 7.4 months (Hazard Ratio (HR) 0.79; 95% confidence interval (CI), 0.52-1.19), and median OS was 14.8 and 15.9 months (HR 0.89; 95% CI 0.57-1.38). Initial dose reduction was significantly more frequent in elderly patients (35.9% vs. 83.0%, P < .001). Any grade AEs occurred in 97.4% and 97.9%, grade 3-4 AEs in 51.3% and 40.4%. Any grade immune-related adverse events (irAEs) in 31.6% and 27.7%, and grade 3-4 irAEs in 6.8% and 6.4% in non-elderly and elderly patients, respectively. Treatment discontinuation due to AEs was observed more frequent in the elderly group (3.4% vs. 17.0%). Fewer elderly patients received subsequent therapy (72.6% vs. 48.5%, P = .01). Conclusions: No clear age-related differences in survival outcomes or safety were observed with first-line immunotherapy plus chemotherapy in this study. However, elderly patients had higher treatment discontinuation and lower subsequent therapy rates, highlighting the importance of individualized dose adjustment and timely disease assessment and close monitoring.
Background Radiotherapy (RT) combined with chemoimmunotherapy may have synergistic effects and improve treatment efficacy and survival in extensive-stage small cell lung cancer (ES-SCLC). However, its association with survival appears to be inconsistent across different metastatic patterns. Methods Patients with metastatic SCLC diagnosed between 2020 and 2023 were identified from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM), Kaplan-Meier analysis, and Cox regression were used to evaluate the association between RT and cancer-specific survival (CSS). Inverse probability of treatment weighting (IPTW) and overlap weighting were performed as sensitivity analyses. Results A total of 4707 patients were included. Liver metastasis was the most common site-specific metastasis (44.1%), followed by bone (42.1%), brain (30.1%), and lung metastasis (16.1%). Multi-organ metastases without brain involvement were the most common metastatic pattern (21.2%), followed by other/unspecified (16.0%) and multi-organ metastases with brain involvement (15.5%). After 1:1 PSM, additional RT was associated with higher CSS in the liver only (HR, 0.68; 95% CI, 0.51-0.91; P = .009), lung only (HR, 0.55; 95% CI, 0.38-0.80; P = .002), multi-organ without brain (HR, 0.77; 95% CI, 0.64-0.92; P = .005), and other/unspecified cohorts (HR, 0.67; 95% CI, 0.54-0.82; P < .001). No significant association was observed in the bone only, brain only, or multi-organ with brain cohorts. IPTW and overlap weighting analyses yielded consistent results. Conclusions In the immunotherapy era, among patients with metastatic SCLC receiving first-line chemoimmunotherapy, the association between additional RT and CSS may vary across metastatic patterns.
Abstract Background Cancer has been the leading cause of death in Japan since the 1980s, with known variation across prefectures, but evidence on how this pattern has changed over time is limited. Methods We analysed age-standardized cancer mortality across all 47 Japanese prefectures in 1995 and 2023 using vital statistics data. For each prefecture, excess mortality was calculated relative to a leave-one-out national reference and standardized to the 1995 national population. Excess mortality was decomposed by cancer site. We also compared prefectures’ age-standardized mortality rates (ASMRs) between the two years. Results All-cancer ASMR declined in every prefecture. In 2023, excess mortality ranged from 32·6 per 100 000 (95% CI 26·8 to 38·4) in Aomori to −22·4 (−26·1 to −18·6) in Nagano, a gap of 55·0 deaths per 100 000, with 30 prefectures differing significantly from the national reference. The geographic pattern shifted between 1995 and 2023. In 1995, excess mortality was concentrated in western Japan, particularly Osaka and Fukuoka, and was largely driven by liver cancer. By 2023, excess mortality had shifted to northern prefectures, led by Aomori and Hokkaido, and was distributed across multiple cancer types, including colorectal, lung, and stomach cancer. The overall gap narrowed from 69·6 to 55·0 per 100 000. Conclusions Geographic inequality in cancer mortality persisted in Japan, but its pattern changed substantially. The findings suggest that national cancer control should monitor subnational inequality directly and support regionally targeted strategies.
